Lung volume reduction surgery - Case selection, operative technique, and clinical results
Lung volume reduction surgery - Case selection, operative technique, and clinical results
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DOI：
10.1097/00000658-199605000-00008
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发表时间：
1996-05-01
影响因子：
9
通讯作者：
Truwit, JD
中科院分区：
文献类型：
--
作者：
Daniel, TM;Chan, BBK;Truwit, JD
目的探讨肺减容术治疗终末期肺气肿的最佳术前策略和术中技巧，以减少并发症和改善患者生理功能。背景肺减容术是治疗终末期慢性阻塞性肺疾病（COPD）的一种替代或过渡性肺移植手术。方法26例患者接受肺减容手术，17例患者随访3个月。分析术前酸和术后肺功能参数、生活质量和需氧量的变化。术前定位病变肺段的价值，这是如何影响术中surviving.Results百分之四十九的改善FEV（1）（1秒用力呼气量）和23%的改善FVC（用力肺活量）肺减容手术后看到。补充氧气需求减少，79%的患者报告生活质量明显改善。结论肺减容术可明显改善终末期肺气肿患者的客观肺功能和主观肺功能，且并发症少，病死率低。仔细的病人选择，准确的术前定位病变的目标区域，熟练的麻醉技术，细致的手术方法，并加强术后支持是必不可少的，以达到良好的效果。
Objective A clinical study was undertaken to define optimal preoperative strategies and intraoperative techniques that would result in the least morbidity and maximum physiologic improvement in patients with end-stage emphysema selected for lung volume reduction surgery,Background Lung volume reduction surgery recently has been advocated as an alternative or a bridge to lung transplantation for patients with end-stage chronic obstructive pulmonary disease. The risks, benefits, and long-term results have not been clarified.Methods Twenty-six patients underwent lung volume reduction surgery with a 3-month follow-up on 17 patients. Preoperative acid postoperative changes in pulmonary function parameters, quality of life, and oxygen requirement were analyzed. The value of preoperative localization of diseased lung segments and how this affects intraoperative resection is addressed.Results Forty-nine percent improvement in FEV(1) (forced expiratory volume in 1 second) and 23% improvement in FVC (forced vital capacity) were seen after lung volume reduction surgery. Supplemental oxygen requirement was decreased and 79% of patients reported a much better quality of life. Mortality was 3.8% and air leak morbidity was 18%.Conclusions Lung volume reduction surgery can predictably improve objective and subjective pulmonary function in selected patients with end-stage emphysema with low morbidity and mortality. Careful patient selection, accurate preoperative localization of diseased target areas, skilled anesthetic technique, meticulous operative approach, and intense postoperative support are essential to achieve favorable results.